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Abstract

Our previous findings suggest that ischemic stroke patients with either type 1 (T1D) or type 2 diabetes mellitus (T2D) exhibit a distinct risk factor and etiologic profile, and a worse vascular prognosis than do nondiabetic patients. We also showed that nonaneurysmal subarachnoid hemorrhage is rather a microvascular than macrovascular complication in T1D. Here, we aimed to compare risk factors, hematoma characteristics, and long-term mortality between diabetic and nondiabetic patients with spontaneous intracerebral hemorrhage (ICH) to provide information for patient management, counseling, and future research in these patient groups. Furthermore, we compared theses features between T1D and T2D patients.

Methods: We included patients with first-ever ICH enrolled in the Helsinki ICH Study and in the Finnish Diabetic Nephropathy Study. Patients were followed using the national death registry. A Cox proportional hazards model adjusting for age at ICH onset, sex, and known ICH prognosticators_Glasgow Coma Scale (GCS) on admission, hematoma volume, infratentorial location, intraventricular hematoma_was constructed to assess, whether diabetes stands as an independent prognosticator.

Results: A total of 972 patients were included, of which 813 (83.6%) were nondiabetic, 45 (4.6%) had T1D, and 120 (12.3%) T2D. Compared with nondiabetic patients, diabetic patients more often men, and they had more frequently hypertension and coronary heart disease. No difference emerged in GCS or hematoma volume, but diabetic patients more often had infratentorial ICH than nondiabetic patients. T1D patients were younger at ICH onset and they more often had brain stem ICH, but less often lobar ICH, than did T2D patients. Cumulative mortality at 12 months for nondiabetic patients was 34.0% (95% confidence interval 30.1-37.9%), for T1D 47.0% (31.3-62.7%), and for T2D 46.0% (36.2-55.8%). In multivariate Cox regression, diabetes was independently associated with higher risk of death (hazard ratio 1.42, 95% confidence interval 1.11-1.82, P=0.005).

Conclusions: ICH patients with diabetes exhibit a distinct pattern of comorbidities and ICH characteristics compared with nondiabetic patients. Diabetes independently decreases the likelihood for survival after an ICH.